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Introdução: A degeneração da articulação patelofemoral é uma patologia relativamente comum, ocorrendo em 5% a 9% dos pacientes com artrose isolada do joelho. Avanço progressivo do processo degenerativo acompanhado de dor, rigidez articular e considerável limitação funcional são achados comumente presentes, tornando-se, muitas vezes, necessária a adoção de intervenções cirúrgicas. O tratamento cirúrgico para pacientes jovens, apresentando estágio avançado de artrose isolada da articulação patelofemoral, permanece controverso. Diversas técnicas cirúrgicas, incluindo liberação do retináculo lateral, avanço da tuberosidade tibial, implante autólogo de condrócitos, patelectomia, artroplastia patelofemoral e artroplastia total do joelho têm sido empregadas, apresentando ampla variação nos índices de sucesso. Além disso, a rotina pós-operatória e a necessidade de imobilização e proteção do reparo, após alguns procedimentos, tendem a repercutir nos resultados funcionais finais e no retorno às atividades de vida diária. Não há solução perfeita para o tratamento cirúrgico da artrose patelofemoral isolada. As opções terapêuticas disponíveis até proporcionam resultados funcionais aceitáveis, mas os problemas inerentes a cada uma delas não podem ser considerados desprezíveis. Algumas das cirurgias sem implantes artificiais costumam comprometer, significativamente, a morfologia articular, com resultados estéticos bastante desconfortáveis, principalmente para pacientes do sexo feminino. As cirurgias com implantes, por outro lado, agregam um custo adicional significativamente alto, na forma do valor intrínseco desses implantes, já que os demais custos hospitalares são equivalentes aos procedimentos convencionais. Dessa forma, o desenvolvimento de um procedimento cirúrgico alternativo, capaz de promover alívio das queixas álgicas, melhora funcional, reabilitação precoce e resultado estético aceitável traria não somente grandes benefícios para os pacientes com artrose patelofemoral em estágios avançados de comprometimento articular, como também certo alívio para os gestores das secretarias municipais de saúde no que se refere ao alto custo dos implantes. Objetivo: Avaliar os resultados funcionais de pacientes com artrose patelofemoral submetidos a uma nova técnica cirúrgica, artroplastia de interposição retinacular. Material e Métodos: O estudo descreve uma série de 11 casos de pacientes com diagnóstico de artrose patelofemoral isolada, submetidos à artroplastia de interposição retinacular no Serviço de Ortopedia e Traumatologia do Hospital de Clínicas de Porto Alegre, que foram avaliados quanto à função e movimento articular do joelho durante o pré e o pós-operatório. O tempo de seguimento pós-operatório foi de, no mínimo, 2 anos. A avaliação da função foi realizada utilizando-se a Escala de Atividades de Vida Diária para Análise do Joelho. As amplitudes de movimento de flexão e extensão do joelho foram mensuradas por meio de um goniômetro universal. Foram comparados os resultados obtidos durante o pré e pós-operatório. Resultados: Após um período médio de seguimento de 25,9 meses (entre 24 e 29 meses), 10 dos 11 pacientes apresentaram melhora nos resultados funcionais. A média de escores da Escala de Atividades de Vida Diária para Análise do Joelho foi 34,0 ± 12,4 (IC 95%=25,7- 42,3) antes da cirurgia e 55,8 ± 11,2 (IC95%=48,3-63,4) após a cirurgia, apresentando uma melhora estatisticamente significativa (p<0,001). O paciente que não evidenciou melhora funcional pós-operatória apresentou progressão da artrose tibiofemoral e, após 2 anos de pós-operatório, foi submetido à artroplastia total do joelho. Não foi observado aumento estatisticamente significativo na amplitude de movimento de flexão e extensão do joelho após a cirurgia. Conclusão: A artroplastia de interposição retinacular proporcionou bons resultados funcionais em pacientes com artrose da articulação patelofemoral, podendo ser uma alternativa cirúrgica para pacientes jovens e de meia idade com processo degenerativo articular em estágio avançado. / Introduction: The degeneration of the patellofemoral joint is a relatively common patology. Patellofemoral artrhosis occurs in between 5% and 9% of patients with knee arthrosis. The frequent clinical findings observed in the presence of progressive degenerative process are pain, joint stiffness, and considerable functional impairment, which many a time requires surgical intervention. Yet, in the case of young patients in an advanced stage of isolated patellofemoral arthrosis, surgical approaches to treatment are surrounded by controversy. Several surgical techniques have been employed to varying degrees of success, including lateral reticular release, advancement of tibial tuberosity, autologous chondrocyte implantation, patellectomy, patellofemoral arthroplasty and total knee arthroplasty. Besides, the different postoperative routines adopted, at times followed by periods of immobilization and protection of the surgical repair performed, tend to lead to different functional outcomes and to influence the resumption of daily living activities. There is no ideal solution to the surgical treatment of isolated patellofemoral arthrosis. The therapeutic alternatives available do indeed manage to produce acceptable outcomes, but the issues inherent to each choice cannot be ignored. Some surgical procedures that do not use artificial implantations usually compromise significantly the joint morphology, and follow-up involves undesired esthetic results, specially for female patients. Conversely, surgeries that use implantations impose rising additional costs expressed by the intrinsic values of the implantation, as the other hospital expenditures are equivalent to conventional medical procedures. Therefore, the development of an alternative surgical procedure that promotes pain relief, functional improvements, with an early rehabilitation and an acceptable esthetic result, would bring not only substantial benefits to patients who suffer from patellofemoral arthrosis with advanced commitment of the joint, but also a certain relief to health authorities as regards high implantation costs. Aim: To evaluate the functional outcomes of patients with patellofemoral arthrosis who underwent a new surgical technique, retinacular interposition arthroplasty. Materials and methods: The present study is a case series. Eleven patients with positive diagnosis for isolated patellofemoral arthrosis who underwent to retinacular interposition arthroplasty were evaluated in the Orthopedics and Traumatology Service of Hospital de Clínicas de Porto Alegre for function and articular range of motion of the knee during the preand postoperative period. Follow-up was at least 2 years. The evaluation of function was carried out using the Knee Outcome Survey Activities of Daily Living Scale. The range of flexion and extension motion were measured by means of a goniometer. Pre- and postoperative results were compared. Results: After an average follow-up period of 25.9 months (between 24 and 29 months), 10 of the 11 patients showed improved functional outcomes. Average scores obtained by the Knee Outcome Survey Activities of Daily Living Scale was 34.0 ± 12.4 (CI 95% = 25.7 – 42.3) before surgery and 55.8 ± 11.2 (CI 95% = 48.3 – 63.4) after surgery, with a statistically significant improvement (P < 0.001). One patient did not present any functional improvement, and presented a progression of the femorotibial arthrosis. Two years after the end of the postoperative period, the patient underwent total knee arthroplasty. No statistically significant increase was observed in motion of knee flexion and extension after the surgery. Conclusion: Retinacular interposition arthroplasty afforded good functional results in patients with isolated arthrosis of the patellofemoral joint. The technique may be a surgical alternative for young and middle-aged patients who suffer from articular degenerative process at advanced stage.

Introdução: A degeneração da articulação patelofemoral é uma patologia relativamente comum, ocorrendo em 5% a 9% dos pacientes com artrose isolada do joelho. Avanço progressivo do processo degenerativo acompanhado de dor, rigidez articular e considerável limitação funcional são achados comumente presentes, tornando-se, muitas vezes, necessária a adoção de intervenções cirúrgicas. O tratamento cirúrgico para pacientes jovens, apresentando estágio avançado de artrose isolada da articulação patelofemoral, permanece controverso. Diversas técnicas cirúrgicas, incluindo liberação do retináculo lateral, avanço da tuberosidade tibial, implante autólogo de condrócitos, patelectomia, artroplastia patelofemoral e artroplastia total do joelho têm sido empregadas, apresentando ampla variação nos índices de sucesso. Além disso, a rotina pós-operatória e a necessidade de imobilização e proteção do reparo, após alguns procedimentos, tendem a repercutir nos resultados funcionais finais e no retorno às atividades de vida diária. Não há solução perfeita para o tratamento cirúrgico da artrose patelofemoral isolada. As opções terapêuticas disponíveis até proporcionam resultados funcionais aceitáveis, mas os problemas inerentes a cada uma delas não podem ser considerados desprezíveis. Algumas das cirurgias sem implantes artificiais costumam comprometer, significativamente, a morfologia articular, com resultados estéticos bastante desconfortáveis, principalmente para pacientes do sexo feminino. As cirurgias com implantes, por outro lado, agregam um custo adicional significativamente alto, na forma do valor intrínseco desses implantes, já que os demais custos hospitalares são equivalentes aos procedimentos convencionais. Dessa forma, o desenvolvimento de um procedimento cirúrgico alternativo, capaz de promover alívio das queixas álgicas, melhora funcional, reabilitação precoce e resultado estético aceitável traria não somente grandes benefícios para os pacientes com artrose patelofemoral em estágios avançados de comprometimento articular, como também certo alívio para os gestores das secretarias municipais de saúde no que se refere ao alto custo dos implantes. Objetivo: Avaliar os resultados funcionais de pacientes com artrose patelofemoral submetidos a uma nova técnica cirúrgica, artroplastia de interposição retinacular. Material e Métodos: O estudo descreve uma série de 11 casos de pacientes com diagnóstico de artrose patelofemoral isolada, submetidos à artroplastia de interposição retinacular no Serviço de Ortopedia e Traumatologia do Hospital de Clínicas de Porto Alegre, que foram avaliados quanto à função e movimento articular do joelho durante o pré e o pós-operatório. O tempo de seguimento pós-operatório foi de, no mínimo, 2 anos. A avaliação da função foi realizada utilizando-se a Escala de Atividades de Vida Diária para Análise do Joelho. As amplitudes de movimento de flexão e extensão do joelho foram mensuradas por meio de um goniômetro universal. Foram comparados os resultados obtidos durante o pré e pós-operatório. Resultados: Após um período médio de seguimento de 25,9 meses (entre 24 e 29 meses), 10 dos 11 pacientes apresentaram melhora nos resultados funcionais. A média de escores da Escala de Atividades de Vida Diária para Análise do Joelho foi 34,0 ± 12,4 (IC 95%=25,7- 42,3) antes da cirurgia e 55,8 ± 11,2 (IC95%=48,3-63,4) após a cirurgia, apresentando uma melhora estatisticamente significativa (p<0,001). O paciente que não evidenciou melhora funcional pós-operatória apresentou progressão da artrose tibiofemoral e, após 2 anos de pós-operatório, foi submetido à artroplastia total do joelho. Não foi observado aumento estatisticamente significativo na amplitude de movimento de flexão e extensão do joelho após a cirurgia. Conclusão: A artroplastia de interposição retinacular proporcionou bons resultados funcionais em pacientes com artrose da articulação patelofemoral, podendo ser uma alternativa cirúrgica para pacientes jovens e de meia idade com processo degenerativo articular em estágio avançado. / Introduction: The degeneration of the patellofemoral joint is a relatively common patology. Patellofemoral artrhosis occurs in between 5% and 9% of patients with knee arthrosis. The frequent clinical findings observed in the presence of progressive degenerative process are pain, joint stiffness, and considerable functional impairment, which many a time requires surgical intervention. Yet, in the case of young patients in an advanced stage of isolated patellofemoral arthrosis, surgical approaches to treatment are surrounded by controversy. Several surgical techniques have been employed to varying degrees of success, including lateral reticular release, advancement of tibial tuberosity, autologous chondrocyte implantation, patellectomy, patellofemoral arthroplasty and total knee arthroplasty. Besides, the different postoperative routines adopted, at times followed by periods of immobilization and protection of the surgical repair performed, tend to lead to different functional outcomes and to influence the resumption of daily living activities. There is no ideal solution to the surgical treatment of isolated patellofemoral arthrosis. The therapeutic alternatives available do indeed manage to produce acceptable outcomes, but the issues inherent to each choice cannot be ignored. Some surgical procedures that do not use artificial implantations usually compromise significantly the joint morphology, and follow-up involves undesired esthetic results, specially for female patients. Conversely, surgeries that use implantations impose rising additional costs expressed by the intrinsic values of the implantation, as the other hospital expenditures are equivalent to conventional medical procedures. Therefore, the development of an alternative surgical procedure that promotes pain relief, functional improvements, with an early rehabilitation and an acceptable esthetic result, would bring not only substantial benefits to patients who suffer from patellofemoral arthrosis with advanced commitment of the joint, but also a certain relief to health authorities as regards high implantation costs. Aim: To evaluate the functional outcomes of patients with patellofemoral arthrosis who underwent a new surgical technique, retinacular interposition arthroplasty. Materials and methods: The present study is a case series. Eleven patients with positive diagnosis for isolated patellofemoral arthrosis who underwent to retinacular interposition arthroplasty were evaluated in the Orthopedics and Traumatology Service of Hospital de Clínicas de Porto Alegre for function and articular range of motion of the knee during the preand postoperative period. Follow-up was at least 2 years. The evaluation of function was carried out using the Knee Outcome Survey Activities of Daily Living Scale. The range of flexion and extension motion were measured by means of a goniometer. Pre- and postoperative results were compared. Results: After an average follow-up period of 25.9 months (between 24 and 29 months), 10 of the 11 patients showed improved functional outcomes. Average scores obtained by the Knee Outcome Survey Activities of Daily Living Scale was 34.0 ± 12.4 (CI 95% = 25.7 – 42.3) before surgery and 55.8 ± 11.2 (CI 95% = 48.3 – 63.4) after surgery, with a statistically significant improvement (P < 0.001). One patient did not present any functional improvement, and presented a progression of the femorotibial arthrosis. Two years after the end of the postoperative period, the patient underwent total knee arthroplasty. No statistically significant increase was observed in motion of knee flexion and extension after the surgery. Conclusion: Retinacular interposition arthroplasty afforded good functional results in patients with isolated arthrosis of the patellofemoral joint. The technique may be a surgical alternative for young and middle-aged patients who suffer from articular degenerative process at advanced stage.

Introdução: A degeneração da articulação patelofemoral é uma patologia relativamente comum, ocorrendo em 5% a 9% dos pacientes com artrose isolada do joelho. Avanço progressivo do processo degenerativo acompanhado de dor, rigidez articular e considerável limitação funcional são achados comumente presentes, tornando-se, muitas vezes, necessária a adoção de intervenções cirúrgicas. O tratamento cirúrgico para pacientes jovens, apresentando estágio avançado de artrose isolada da articulação patelofemoral, permanece controverso. Diversas técnicas cirúrgicas, incluindo liberação do retináculo lateral, avanço da tuberosidade tibial, implante autólogo de condrócitos, patelectomia, artroplastia patelofemoral e artroplastia total do joelho têm sido empregadas, apresentando ampla variação nos índices de sucesso. Além disso, a rotina pós-operatória e a necessidade de imobilização e proteção do reparo, após alguns procedimentos, tendem a repercutir nos resultados funcionais finais e no retorno às atividades de vida diária. Não há solução perfeita para o tratamento cirúrgico da artrose patelofemoral isolada. As opções terapêuticas disponíveis até proporcionam resultados funcionais aceitáveis, mas os problemas inerentes a cada uma delas não podem ser considerados desprezíveis. Algumas das cirurgias sem implantes artificiais costumam comprometer, significativamente, a morfologia articular, com resultados estéticos bastante desconfortáveis, principalmente para pacientes do sexo feminino. As cirurgias com implantes, por outro lado, agregam um custo adicional significativamente alto, na forma do valor intrínseco desses implantes, já que os demais custos hospitalares são equivalentes aos procedimentos convencionais. Dessa forma, o desenvolvimento de um procedimento cirúrgico alternativo, capaz de promover alívio das queixas álgicas, melhora funcional, reabilitação precoce e resultado estético aceitável traria não somente grandes benefícios para os pacientes com artrose patelofemoral em estágios avançados de comprometimento articular, como também certo alívio para os gestores das secretarias municipais de saúde no que se refere ao alto custo dos implantes. Objetivo: Avaliar os resultados funcionais de pacientes com artrose patelofemoral submetidos a uma nova técnica cirúrgica, artroplastia de interposição retinacular. Material e Métodos: O estudo descreve uma série de 11 casos de pacientes com diagnóstico de artrose patelofemoral isolada, submetidos à artroplastia de interposição retinacular no Serviço de Ortopedia e Traumatologia do Hospital de Clínicas de Porto Alegre, que foram avaliados quanto à função e movimento articular do joelho durante o pré e o pós-operatório. O tempo de seguimento pós-operatório foi de, no mínimo, 2 anos. A avaliação da função foi realizada utilizando-se a Escala de Atividades de Vida Diária para Análise do Joelho. As amplitudes de movimento de flexão e extensão do joelho foram mensuradas por meio de um goniômetro universal. Foram comparados os resultados obtidos durante o pré e pós-operatório. Resultados: Após um período médio de seguimento de 25,9 meses (entre 24 e 29 meses), 10 dos 11 pacientes apresentaram melhora nos resultados funcionais. A média de escores da Escala de Atividades de Vida Diária para Análise do Joelho foi 34,0 ± 12,4 (IC 95%=25,7- 42,3) antes da cirurgia e 55,8 ± 11,2 (IC95%=48,3-63,4) após a cirurgia, apresentando uma melhora estatisticamente significativa (p<0,001). O paciente que não evidenciou melhora funcional pós-operatória apresentou progressão da artrose tibiofemoral e, após 2 anos de pós-operatório, foi submetido à artroplastia total do joelho. Não foi observado aumento estatisticamente significativo na amplitude de movimento de flexão e extensão do joelho após a cirurgia. Conclusão: A artroplastia de interposição retinacular proporcionou bons resultados funcionais em pacientes com artrose da articulação patelofemoral, podendo ser uma alternativa cirúrgica para pacientes jovens e de meia idade com processo degenerativo articular em estágio avançado. / Introduction: The degeneration of the patellofemoral joint is a relatively common patology. Patellofemoral artrhosis occurs in between 5% and 9% of patients with knee arthrosis. The frequent clinical findings observed in the presence of progressive degenerative process are pain, joint stiffness, and considerable functional impairment, which many a time requires surgical intervention. Yet, in the case of young patients in an advanced stage of isolated patellofemoral arthrosis, surgical approaches to treatment are surrounded by controversy. Several surgical techniques have been employed to varying degrees of success, including lateral reticular release, advancement of tibial tuberosity, autologous chondrocyte implantation, patellectomy, patellofemoral arthroplasty and total knee arthroplasty. Besides, the different postoperative routines adopted, at times followed by periods of immobilization and protection of the surgical repair performed, tend to lead to different functional outcomes and to influence the resumption of daily living activities. There is no ideal solution to the surgical treatment of isolated patellofemoral arthrosis. The therapeutic alternatives available do indeed manage to produce acceptable outcomes, but the issues inherent to each choice cannot be ignored. Some surgical procedures that do not use artificial implantations usually compromise significantly the joint morphology, and follow-up involves undesired esthetic results, specially for female patients. Conversely, surgeries that use implantations impose rising additional costs expressed by the intrinsic values of the implantation, as the other hospital expenditures are equivalent to conventional medical procedures. Therefore, the development of an alternative surgical procedure that promotes pain relief, functional improvements, with an early rehabilitation and an acceptable esthetic result, would bring not only substantial benefits to patients who suffer from patellofemoral arthrosis with advanced commitment of the joint, but also a certain relief to health authorities as regards high implantation costs. Aim: To evaluate the functional outcomes of patients with patellofemoral arthrosis who underwent a new surgical technique, retinacular interposition arthroplasty. Materials and methods: The present study is a case series. Eleven patients with positive diagnosis for isolated patellofemoral arthrosis who underwent to retinacular interposition arthroplasty were evaluated in the Orthopedics and Traumatology Service of Hospital de Clínicas de Porto Alegre for function and articular range of motion of the knee during the preand postoperative period. Follow-up was at least 2 years. The evaluation of function was carried out using the Knee Outcome Survey Activities of Daily Living Scale. The range of flexion and extension motion were measured by means of a goniometer. Pre- and postoperative results were compared. Results: After an average follow-up period of 25.9 months (between 24 and 29 months), 10 of the 11 patients showed improved functional outcomes. Average scores obtained by the Knee Outcome Survey Activities of Daily Living Scale was 34.0 ± 12.4 (CI 95% = 25.7 – 42.3) before surgery and 55.8 ± 11.2 (CI 95% = 48.3 – 63.4) after surgery, with a statistically significant improvement (P < 0.001). One patient did not present any functional improvement, and presented a progression of the femorotibial arthrosis. Two years after the end of the postoperative period, the patient underwent total knee arthroplasty. No statistically significant increase was observed in motion of knee flexion and extension after the surgery. Conclusion: Retinacular interposition arthroplasty afforded good functional results in patients with isolated arthrosis of the patellofemoral joint. The technique may be a surgical alternative for young and middle-aged patients who suffer from articular degenerative process at advanced stage.

Abstract The treatment of hip fractures in the elderly has been under debate for decades. There is a lack of standardisation of treatment and rehabilitation and also concerning the measurements and follow-up times in studies on treatment. Two patient series with cervical hip fractures treated with Austin Moore hemiarthroplasty in Finland and hook pin osteosynthesis in Sweden were compared using matched-pair analysis in view of different age groups. Hip fracture treatments in six hospitals in Finland and one in Great Britain were surveyed. The adequacy of a short four-month follow-up was studied by comparing outcomes at four months and one year. Standardised Audit of Hip Fractures in Europe data collection sets were tested and used in three studies. Osteosynthesis resulted in lower one-year mortality but a higher reoperation rate in patients aged 55–75 years and was associated with a lesser need for walking aids, less pain and lower four-month mortality in patients aged 76–80 years. There were some differences in the patient characteristics and the methods of treatment between Great Britain and Finland. In Great Britain, more patients returned to their own homes, but one-year mortality after trochanteric fractures was higher. Hip fracture treatments and outcomes were quite similar between the six Finnish hospitals. There was a slight difference in adjusted postoperative mobility and mortality in two hospitals compared to the others. Six of the ten functional domains and residential status remained unchanged, while walking ability and four functional domains improved between four months and one year. The standardised data set was a practical and reliable way to acquire a great variety of information on hip fracture patients, treatments and outcomes. Hook pin osteosynthesis can be recommended for patients with cervical hip fractures younger than 80 years, whereas older patients can also be safely treated with Austin Moore hemiarthroplasty. The characteristics and outcomes of hip fracture patients were rather similar between Finland and Great Britain and between the different Finnish hospitals irrespective of the variety of methods used in treatment. Standardised Audit for Hip Fractures in Europe is a reliable data collection set and suitable as a basis of hip fracture surveys, audits and registers. Four-month follow-up is justified as the shortest feasible alternative in studies on rehabilitation and residential status after hip fractures.

Bipolar Disorder is frequently associated with a number of poor outcomes including, but not limited to, a significant impairment in the ability to return to premorbid levels of occupational and psychosocial functioning, often despite the remission of mood symptoms. An extensive line of research has pointed toward deficits in cognitive functioning as playing an important role in this persistent disability, with a number of studies demonstrating the presence of numerous cognitive impairments during the inter-episode period. Also present during affective episodes as well as the inter-episode periods are reports of pervasive sleep disturbance. Sleep disturbance has been associated with the onset of manic episodes and is an oft-reported prodrome of illness onset. Despite the presence of deficits in these two domains of functioning during affective episodes as well as the inter-episode phase, there has been no evaluation of the degree to which these systems may interact to maintain such high rates of functional disability. The current study attempted to integrate these three separate lines of research to examine the role sleep disruption plays in both cognitive and occupational functioning in individuals with bipolar disorder. Seventy-two males and females with bipolar disorder in the euthymic phase (n=24), primary insomnia (n=24) or no psychological or medical diagnoses (n=24) completed a week of prospective assessment of sleep disruption via self-report and actigraphy. At the culmination of the sleep assessment period, all participants were administered a battery of neuropsychological tests of executive functioning, working memory, verbal learning, and attention. Additionally, participants completed self-reports of mood symptoms and current and lifetime occupational functioning. Results were mixed relative to hypotheses. Data supports persistent sleep disturbance among individuals with bipolar disorder when assessed via self-report, but no significant differences were observed compared to controls when assessed via actigraphy. Bipolar participants exhibited significantly poorer performance on measures of verbal learning and working memory, but no other cognitive deficits were observed relative to insomnia and control participants. Bipolar participants had a greater lifetime history of being fired compared to insomnia or control participants, and deficits in executive inhibition and switching were associated with increased lifetime firings across the sample. Sleep disturbance, either subjective or objective, failed to mediate this association. Findings are partially consistent with previous reports of persistent sleep disturbance and cognitive impairment among individuals with BD in the euthymic phase. More research should be conducted to better understand the underpinnings of functional impairment in BD. / Psychology

Autism spectrum disorder (ASD) is a neurodevelopmental disorder characterized by impairments in communication and socialization, as well as by repetitive and stereotyped behaviours and interests. The ASD phenotype is also characterized by impairments in cognition. A growing body of literature points to attention and executive functioning as being key elements of cognition that are impaired in individuals with ASD. It is very possible that these cognitive difficulties are related to the functional deficits in academic achievement, daily living skills and socialization that are experienced by individuals with ASD throughout their lifetime. Associations between these cognitive and functional abilities have been identified in TD populations; however, this relationship is not well understood in ASD. This is especially true for adolescents with ASD who are a vastly understudied population within the field. The research in this thesis aimed to investigate the nature of cognitive and functional impairments in high-functioning adolescents with ASD, and to better understand the relationship between these deficits. This study made use of a multi-method approach, by obtaining behavioural and parent-report data related to cognition and functioning for both ASD and TD populations. The results indicated that adolescents with ASD may have some impairment in executive functioning, particularly with shifting and planning abilities, and score significantly lower than TD adolescents on measures of academic achievement, adaptive behaviour and social skills. Surprisingly, no evidence was found for attentional deficits in the ASD group. Multiple regression analyses did not reveal any significant predictive relationships of attention and executive functioning with academic ability, adaptive behaviour, or social skills. Limitations of this research are discussed. The results may lend themselves to the development of theoretical frameworks for understanding functional abilities in adolescents with ASD. / Thesis (Master, Psychology) -- Queen's University, 2013-10-07 10:10:42.215

Few authors report comprehensive psychometric data for their acquired brain injury (ABI) outcome indices (e.g., items analyses, test-retest reliability, survivor-proxy agreement, internal consistency, convergent validity). Even fewer authors submit their indices to modern psychometric analyses, like Rasch analysis. The purpose of this dissertation was to evaluate the traditional and modern psychometric properties of a new index of brain injury outcome: the Functional Outcome Profile (FOP). One hundred and thirteen mixed (estimated mild, moderate, and severe injury) ABI survivors and 22 significant others participated in the study. Items analyses (n = 113) revealed that all items were endorsed by at least one ABI survivor, suggesting that the FOP assessed areas relevant to ABI survivors. However most items, composite scores, and the total score had distributions that were negatively skewed. One-week test-retest reliability correlations for the total score, composites, and items (n = 25) were generally in the moderate to strong range (r > 0.7), while survivor-proxy agreement correlations for the items (n = 22) were generally in the moderate range (r = 0.5 to 0.7). The internal consistency scores (n = 113) for 5 of the 8 composite scales and for the full FOP were good (Cronbach α > 0.7). Concurrent-convergent validity analyses revealed that the FOP correlated moderately well with the Mayo-Portland Adaptability Index (MPAI-4) (r = -0.75), but that it did not correlate with injury-related information (e.g., age at injury, time since injury, estimated severity). Rasch calibration of the FOP resulted in a 62-item index that fit the Rasch model well and that demonstrated good reliability and separation. Overall, the results suggest that the FOP has good traditional and modern psychometric properties when used with community-based outpatient ABI survivors. Future studies with the FOP should focus on improving the FOP’s clinical utility and further verifying its convergent and divergent validity.

Few authors report comprehensive psychometric data for their acquired brain injury (ABI) outcome indices (e.g., items analyses, test-retest reliability, survivor-proxy agreement, internal consistency, convergent validity). Even fewer authors submit their indices to modern psychometric analyses, like Rasch analysis. The purpose of this dissertation was to evaluate the traditional and modern psychometric properties of a new index of brain injury outcome: the Functional Outcome Profile (FOP). One hundred and thirteen mixed (estimated mild, moderate, and severe injury) ABI survivors and 22 significant others participated in the study. Items analyses (n = 113) revealed that all items were endorsed by at least one ABI survivor, suggesting that the FOP assessed areas relevant to ABI survivors. However most items, composite scores, and the total score had distributions that were negatively skewed. One-week test-retest reliability correlations for the total score, composites, and items (n = 25) were generally in the moderate to strong range (r > 0.7), while survivor-proxy agreement correlations for the items (n = 22) were generally in the moderate range (r = 0.5 to 0.7). The internal consistency scores (n = 113) for 5 of the 8 composite scales and for the full FOP were good (Cronbach α > 0.7). Concurrent-convergent validity analyses revealed that the FOP correlated moderately well with the Mayo-Portland Adaptability Index (MPAI-4) (r = -0.75), but that it did not correlate with injury-related information (e.g., age at injury, time since injury, estimated severity). Rasch calibration of the FOP resulted in a 62-item index that fit the Rasch model well and that demonstrated good reliability and separation. Overall, the results suggest that the FOP has good traditional and modern psychometric properties when used with community-based outpatient ABI survivors. Future studies with the FOP should focus on improving the FOP’s clinical utility and further verifying its convergent and divergent validity.

Abstract Hip fracture is a trauma with serious consequences, especially in the elderly. Etiological factors should be known better than nowadays to recognize the individuals at high risk. Also, the treatment of displaced femoral neck fractures has been controversial, and the factors leading to a functional outcome are not known well. The true impact of deep infection on the outcome after hip fracture surgery has also been insufficiently examined. The thesis is based on two etiological studies. In the first study, the geometrical parameters of the upper femur and pelvis in postmenopausal women with hip fracture were (n=70) compared to age-adjusted controls (n=40). Measurements were made from position-standardized and calibrated pelvic plain x-rays. The differences between the two different types of hip fracture, femoral neck fractures (n=46) and trochanteric fractures (n=24) were also defined. High femoral neck/shaft angle (NSA), thin femoral cortices, low femoral shaft diameter (FSD) and trochanter width and the pelvic dimensions associate strongly with the hip fracture risk in postmenopausal women. Greater NSA, smallest outer pelvic diameter and acetabular width, narrower FSD and smaller femoral neck/shaft cortex ratio were associated with femoral neck fracture rather than trochanteric fracture in postmenopausal women. In the second study, lifetime factors, some bone metabolism markers and bone mineral density were analyzed from postmenopausal women (n=74; 49 with femoral neck fracture, 25 with trochanteric fracture) and age-adjusted controls (n=40). Impaired functional ability, use of loop diuretics, antidiabetic, antidepressant and neuroleptic drugs, some concurrent diseases, such as stroke, diabetes, malignancy, cardiovascular diseases, low bone mineral density of the upper femur, low serum calcium, low serum 25-hydroxyvitamin D and high serum calcitonin, seem to be related to the risk of hip fracture, while low bone mineral density and low serum calcitonin are related to the trochanteric type of fracture in postmenopausal women. The treatment of displaced femoral fractures included two prospective case-control studies, and the first of these involved a comparison (357 matched pairs) of patients with osteosynthesis (OS) with two pins in Lund and patients with uncemented hemiarthroplasty (HA) in Oulu. The patients treated with OS had 4 months after fracture better ambulatory capacity, used walking aids less often and had less pain than the patients treated with HA. The other comparison (84 matched pairs) was made between OS with three screws and uncemented HA, and it revealed no significant differences between HA and OS in the short-term functional outcome. Both studies revealed a higher re-operation rate in OS patients than uncemented HA patients. The case-control study with 29 matched pairs showed that deep infection after a hip fracture operation impairs the short-term functional outcome and slightly increases mortality, with an attributable mortality rate of 10 %. In conclusion, this thesis suggests that the geometry of the upper femur and pelvis, the aforesaid lifetime factors, the aforesaid metabolism markers and bone mineral density are associated with the etiopathology and type of hip fracture in postmenopausal women. The short-term functional outcome was better in OS patients treated with two pins compared to uncemented HA, but the higher re-operation rate should be considered among the OS patients. Deep infection is a serious complication of hip fracture surgery, which impairs function and increases mortality.